An Incomplete Recovery: Youth Unemployment in Europe 2008 – 2016

After having endured many years of economic decline and other problems as- sociated with the financial and economic crisis between 2008 and 2013, most EU member states have resumed their upward trend. This development is due primarily to ongoing improvements in the labour market1. Although not all EU member states have achieved their pre-crisis unemployment levels (EU average in 2008: 7%), the average unemployment rate has fallen from its high point of 11% in 2013 to 8.7% in 2016. Similar trends hold true in Europe for youth unemployment levels, which bears particular consequences for unem- ployment and economic growth overall. This paper takes a closer look at this topic and its development since the Great Recession, thereby highlighting the situation among different subgroups of young people in EU countries. Ten years ago, youth labour markets in Europe and beyond were hit hard by the Great Recession, leaving many young people to struggle with finding and retaining sustainable jobs in a protracted period of (multiple) recession(s). At the height of the youth employment crisis in 2012/2013, more than 9 million young people aged 15-29 across the EU were unemployed, 3 million more than in 2007. Since then, the youth labour market has improved, though perfor- mance indicators have not yet returned to pre-crisis levels. Since 2013, some member states have seen stronger improvements in this re- gard than others, although this varies among different subgroups of young people. Clearly, integrating young people into education, employment and training systems poses a long-term policy challenge for all member states. Persistent structural problems in European labour markets make an immi- nent, rapid improvement of the situation for young people unlikely. Further action is thus needed to support this demographic in fulfilling their potential in European economies and societies. The EU has responded to this youth employment crisis by proposing a range of successive policy measures. Its most prominent recommendations include the call to establish a Youth Guarantee2 and the Youth Employment Initiative. The Youth Guarantee shall ensure that young people have access to quality employment, education, apprenticeship or training opportunities within four months of becoming unemployed. The Youth Employment Initiative provides additional funding to tackle high rates of young people not in employment, education or training (NEET) in European regions most affected by youth unemployment

Assessment of antimicrobial use and prescribing practices among paediatric inpatients in Zimbabwe

Background: Antimicrobial resistance threatens our ability to effectively treat infections. A key driver is inappropriate antimicrobial use. There is currently limited information on antibiotic utilisation in Zimbabwe including children. Consequently, the objective of this study was to assess antimicrobial consumption in the paediatric department of a tertiary care public hospital in Zimbabwe. Methods: Clinical records of paediatric inpatients admitted to two general paediatric wards at Harare Central Hospital over a 3-week period were reviewed prospectively. Antimicrobial consumption was described as days of therapy per 100 inpatient days (DOT/100 PD). Adherence of antimicrobial drug prescriptions to the National Guidelines was also evaluated. Results: A total of 121 (93.1%) children were prescribed at least one antimicrobial out of 130 children admitted. The median age was 14 months (IQR: 3 – 48 months). Overall antimicrobial consumption was 155.4 DOT / 100 PD (95% CI 146-165.2). The most frequently prescribed antimicrobials were benzylpenicillin, gentamicin and ceftriaxone. In 111 children, adherence to national guidelines was evaluated and 64 (57.7%) received antimicrobials according to guidelines. For instance, in children admitted with neonatal sepsis, nonadherence (64%) mostly due to prescribing of ceftriaxone or benzylpenicillin and gentamicin versus cloxacillin and gentamicin. Conclusions: There is high antimicrobial drug usage in hospitalized children in Zimbabwe and a considerable proportion of prescriptions are non-adherent with national guidelines. These findings emphasize the need for antimicrobial stewardship programmes across Zimbabwe and for strengthening diagnostic capacity in low-income settings which is a concern enhancing AMR rates

Factors associated with violence against children in low- and middle-income countries:A systematic review and meta-regression of nationally representative data

Background: This systematic review and meta-regression sought to identify the relative importance of factors associated with physical, emotional, and sexual violence against children in low- and middle-income countries. Understanding of factors associated with violence is important for targeted programming and prevention on the population level. Methods: We searched 17 electronic databases from 1989 to 2018 and reports from child violence surveys. Nationally representative studies that described evidence on potential factors associated with violence against children under 18 years old were included. The search was restricted to the English language. Factors were synthesized quantitatively using robust variance estimation, with 95% confidence intervals, for each violence type. Results: We identified 8,346 unduplicated studies, and 103 publications met our eligibility criteria. The data distribution was uneven across region, country income status, factors, and violence types. Of the 94 eligible studies quantitatively synthesized, no specific factors were significant for physical violence. Lower household socioeconomic status, being a girl, and primary education of mothers and adults in the household were associated with emotional violence, and being a girl was associated with sexual violence. Conclusion: A broad spectrum of factors merit consideration for physical violence policy and prevention among the general population of children in low- and middle-income countries. Conversely, a tailored approach may be warranted for preventing emotional and sexual violence. Information is unequally distributed across countries, factors, and violence types. Greater emphasis should be placed on collecting representative data on the general population and vulnerable subgroups to achieve national reductions in violence against children. </jats:sec

Appraisal of health care: from patient value to societal benefit

Aim: This paper summarizes the deficiencies and weaknesses of the most frequently used methods for the allocation of health-care resources. New, more transparent and practical methods for optimizing the allocation of these resources are proposed. Method: The examples of quality-adjusted life years (QALYs) and efficiency frontier (EF) are analyzed to describe weaknesses and problems in decisions regulating health-care provision. After conducting a literature search and discussions with an international group of professionals, three groups of professionals were formed to discuss the assessment and appraisal of health-care services and allocation of available resources. Results: At least seven essential variables were identified that should be heeded when applying the concept of QALYs for decisions concerning health-care provision. The efficiency frontier (EF) concept can be used to set a ceiling price and perform a cost-benefit analysis of provision, but different stakeholders—a biostatistician (efficacy), an economist (costs), a clinician (effectiveness), and the patient (value)—could provide a fairer appraisal of health-care services. Efficacy and costs are often based on falsifiable data. Effectiveness and value depend on the success with which a particular clinical problem has been solved. These data cannot be falsified. The societal perspective is generated by an informal cost-benefit analysis including appraisals by the above-mentioned stakeholders and carried out by an authorized institution. Conclusion: Our analysis suggests that study results expressed in QALYs or as EF cannot be compared unless the variables included in the calculation are specified. It would be far more objective and comprehensive if an authorized institution made an informal decision based on formal assessments of the effectiveness of health-care services evaluated by health-care providers, of the value assessed by consumers, of efficacy described by biostatisticians, and of costs calculated by economists

Adaptive Equalization and Capacity Analysis for Amplify-and-Forward Relays

Recent research has shown that multiple-input multiple-output (MIMO) systems provide high spectral efficiencies and error performance gains. However, the use of multiple antennas in mobile terminals may not be very practical. Certainly there is limited space and other implementation issues which make this a challenging problem. Therefore, to harness the diversity gains afforded by MIMO transmitter diversity techniques, while maintaining a minimal number of antennas on each handset, cooperative diversity techniques have been proposed. In addition, attention has also been given to combining wireless relaying systems with MIMO techniques to improve capacity, coverage, and obtain better diversity at the expense of increased node complexity. This thesis considers the design and analysis of cooperative diversity systems and MIMO amplify-and-forward relaying systems. In particular, we investigate adaptive time- and frequency-domain equalization techniques for cooperative diversity systems using space-time block codes (STBC). For MIMO relaying systems, we analyze the ergodic capacity of various systems and compare different amplify-and-forward methods in terms of system capacity performance. We propose a new block time-domain adaptive equalization structure for time reversal-space time block coding (TR-STBC) systems, which eliminates the separate decoder and also the need for explicit channel state information (CSI) estimation at the receiver. Our simulation results show that the time-domain adaptive block equalizer performs better than the frequency-domain counterpart but at the cost of increased complexity. Then, we extend this time-domain adaptive equalization scheme to distributed TR-STBC systems. We also develop a frequency-domain counterpart for the distributed systems. Our simulation results show that the adaptive algorithms work well for Protocols I and III proposed by Nabar et al. The time-domain adaptive algorithms perform better than the frequency-domain algorithms, and overall the Protocol I receivers outperform the Protocol III receivers. We also show that, if only the Protocol III receiver is used, it can be susceptible to noise amplification due to a weaker source-to-relay link compared to the relay-to-destination link. This problem can be mitigated by using the Protocol I receivers with some extra complexity but much superior diversity performance. We also present an ergodic capacity analysis of an amplify-and-forward (AF) MIMO two-hop system including the direct link and validate the analysis with simulations. We show that having the direct link improves the capacity due to diversity and quantify this improvement. We also present an ergodic capacity analysis of an AF MIMO two-hop, two relay system. Our results verify the capacity gain of relaying systems with two relays due to the extra diversity compared to a single relaying system. However, the results also show that when one of the source-to-relay links has a markedly higher SNR compared to the other, a single relay system has better capacity than a two relay system. Finally, we compare three types of relay amplification methods: a) average amplification, b) instantaneous channel amplification, and c) instantaneous power amplification. The instantaneous power amplification method has a higher mean capacity but with a higher variance. Also, it requires additional information at the destination and would create enormous overheads compared to the other methods. We also find that the instantaneous channel amplification method has almost no advantage in terms of the mean capacity but its capacity is less variable than the average amplification method. On the other hand, the average amplification method is simpler to implement as it does not require channel estimation at the relaying terminal

New ILAE versus previous clinical status epilepticus semiologic classification: Analysis of a hospital-based cohort.

OBJECTIVES: In 2015, the International League Against Epilepsy (ILAE) issued a new status epilepticus (SE) classification, including a detailed semiologic axis. This study assesses frequencies of SE forms in a cohort of adult patients, and explores differences and practical implications as compared to a seizure-type-bound classification. METHODS: The prospective adult SE registry of the Lausanne University Hospital (CHUV) was considered over 5 years (2011-2015); each SE episode was retrospectively reclassified for its semiology according to the new ILAE scheme. Mortality rates were retrieved for each subgroup of SE. RESULTS: Among 488 SE episodes, according to the seizure-type-bound classification, 230 (47%) had a generalized convulsive, and 29 (6%) had a nonconvulsive SE in coma; both categories overlapped almost perfectly between the two classifications. However, the 84 episodes with focal SE without consciousness impairment and the 141 episodes with consciousness impairment were each translated into two major (and five sub-) categories of the new ILAE classification, having markedly different mortality rates. In addition, of 140 episodes labeled as focal motor SE according to the new classification, 54% had concomitant consciousness impairment, whereas 46% did not; again, mortality rates were heterogeneous. SIGNIFICANCE: Although generalized convulsive and nonconvulsive SE in coma show an almost perfect correspondence across SE semiologic classifications, focal SE is markedly heterogeneous and appears to be better reflected in the new classification, offering more clinically relevant subdivisions, also differing in mortality rates. This refined knowledge may allow the development of clinical prognostic scores that are more precise than existing tools, and should be taken into account for epidemiologic studies

EFNS guideline on the management of status epilepticus in adults

The objective of the current article was to review the literature and discuss the degree of evidence for various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE for relevant literature from 1966 to January 2005 and in the current updated version all pertinent publications from January 2005 to January 2009. Furthermore, the Cochrane Central Register of Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach. Where there was a lack of evidence but consensus was clear, we have stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive status epilepticus (GCSE) is intravenous (i.v.) administration of 4-8 mg lorazepam or 10 mg diazepam directly followed by 18 mg/kg phenytoin. If seizures continue more than 10 min after first injection, another 4 mg lorazepam or 10 mg diazepam is recommended. Refractory GCSE is treated by anaesthetic doses of barbiturates, midazolam or propofol; the anaesthetics are titrated against an electroencephalogram burst suppression pattern for at least 24 h. The initial therapy of non-convulsive SE depends on type and cause. Complex partial SE is initially treated in the same manner as GCSE. However, if it turns out to be refractory, further non-anaesthetising i.v. substances such levetiracetam, phenobarbital or valproic acid should be given instead of anaesthetics. In subtle SE, in most patients, i.v. anaesthesia is required

Psychogenic Elaboration of Simple Partial Seizures

Seizures that cause loss of consciousness (LOC) can be classified as epileptic or nonepileptic based on evaluation of ictal semiology and analysis of changes in EEG events, recorded with continuous scalp EEG and video monitoring. We report 3 patients who had hippocampal electrographic seizures documented with intracranial EEG recording with no accompanying scalp EEG change immediately preceding psychogenic unresponsiveness. Each patient also had complex partial seizures (CPS) originating in the hippocampus. Some individuals can have complex interactions of epileptic and nonepileptic seizures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66184/1/j.1528-1157.1995.tb00471.x.pd

Assessment of antimicrobial use and prescribing practices among pediatric inpatients in Zimbabwe.

This study aims to assess antimicrobial consumption in the pediatric department of a tertiary care public hospital in Zimbabwe. Clinical records of pediatric inpatients admitted to Harare Central Hospital over a 3-week period were reviewed prospectively. Antimicrobial consumption was described as days of therapy per 100 inpatient days (DOT/100 PD). Adherence of antimicrobial drug prescriptions to the National Guidelines was also evaluated. A total of 121 (93.1%) children were prescribed at least one antimicrobial out of 130 children admitted. The median age was 14 months (IQR: 3 - 48 months). Overall antimicrobial consumption was 155.4 DOT/100 PD (95% CI 146-165.2). The most frequently prescribed antimicrobials were benzylpenicillin, gentamicin and ceftriaxone. Prescriptions were adherent to national guidelines in 57.7% of children. This study shows that there is high antimicrobial drug usage in hospitalized children in Zimbabwe and a considerable proportion of prescriptions are non-adherent with national guidelines

Ictal Behaviors During Nonepileptic Seizures Differ in Patients with Temporal Lobe Interictal Epileptiform EEG Activity and Patients Without Interictal Epileptiform EEG Abnormalities

Purpose: Ictal behaviors during psychogenic non-epileptic seizures (NES) vary considerably among individuals, and can closely resemble common semiologies of epileptic seizures (ES). We tested the hypothesis that behaviors during NES in patients who have temporal spikes would more closely resemble behaviors during ES in patients with temporal lobe epilepsy than would behaviors during NES in patients who do not have EEG spikes. Methods: We identified 20 patients who had interictal temporal EEG spikes and EEG-video recorded NES (Study Group), 133 patients with temporal EEG spikes and recorded ES, without NES (Epileptic Group), and 24 patients with recorded NES and no epileptiform EEG abnormalities, without ES (Nonepileptic Group). Results: The hypothesis was supported with regard to ictal motor behaviors. Motionless staring or complex automatisms occurred mainly during NES in the Study Group and during ES in the Epileptic Group. In contrast, convulsive movements or flaccid falls were most common during NES in the Nonepileptic Group. Duration of unresponsiveness was longer, and there were fewer postictal states in NES both in the Study and Non-epileptic Groups. Unresponsiveness was briefer and postictal states were more consistent in ES in the Epileptic Group, however. Conclusions: Stereotyped motor activities during NES presumably represent learned behaviors. Processes underlying acquisition of ictal behaviors of NES probably differ in patients with interictal epileptiform EEG abnormalities compared to those without. Prior experiences and temporal lobe dysfunctions that are associated with epilepsy, and psychological characteristics that are unrelated to interictal epileptic dysfunctions, may determine ictal behaviors during NES.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65913/1/j.1528-1157.1998.tb01355.x.pd